| NPI | 1174656813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MA 1990) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MA 806) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2007-07-08 |