| NPI | 1275944670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA GA1950) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA GA1950) |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2014-05-20 |