| NPI | 1366655300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 2052) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0161861) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2014-01-30 |