| NPI | 1326112699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MO 002100) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KS 336) |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2007-07-08 |