| NPI | 1194057364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 6176) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MT 1417) |
| Enumeration Date | 2010-02-12 |
| Last Update Date | 2011-12-12 |