| NPI | 1245383694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 341) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 213) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2007-07-08 |