| NPI | 1306095393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 0821) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2009-03-03 |