| NPI | 1376715938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 0119291) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM T-0111851) |
| Enumeration Date | 2008-03-24 |
| Last Update Date | 2009-03-26 |