| NPI | 1164521555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 6601) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA MFT23486) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2016-11-09 |