| NPI | 1174652549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 0680000672) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NH 606) |
| Enumeration Date | 2007-03-03 |
| Last Update Date | 2007-07-08 |