| NPI | 1366510141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SD LSWA1015) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: SD LPCMH2004) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2014-08-18 |