| NPI | 1336283001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NH 863) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ME CC3023) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2011-10-04 |