| NPI | 1346486065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 986003) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 6050) |
| Enumeration Date | 2008-12-30 |
| Last Update Date | 2008-12-30 |