| NPI | 1356514327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC 8525) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IN 39001531A) |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2011-10-10 |