| NPI | 1235209602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 06381) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MA 06381) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2008-03-07 |