| NPI | 1386936219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: GA 782311) |
| Enumeration Date | 2011-05-11 |
| Last Update Date | 2011-05-11 |