| NPI | 1184812679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AL 864) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2014-11-06 |