| NPI | 1336346592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 0142501) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0103351) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2012-01-30 |