| NPI | 1336293810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM I-05304) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-07-08 |