| NPI | 1164579314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 130743-030) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2012-02-01 |