| NPI | 1356586200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KS 6933) |
| Additional Taxonomies | 104100000X Social Worker (Licence: KS 6933) |
| Enumeration Date | 2008-12-06 |
| Last Update Date | 2009-11-03 |