| NPI | 1376612382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2004014990) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MO 2004014990) |
| 101YM0800X Counselor, Mental Health (Licence: MO 2004014990) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2013-05-08 |