| NPI | 1366637530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC1513) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MD LC1513) |
| 101YM0800X Counselor, Mental Health (Licence: MD LC1513) | |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2007-10-27 |