| NPI | 1255511523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA 38) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 2359) |
| Enumeration Date | 2007-11-05 |
| Last Update Date | 2007-11-05 |