| NPI | 1194742817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 745) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 00050) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-07-09 |