| NPI | 1396714721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AR 79-16E) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 11238) |
| 101YP2500X Counselor, Professional (Licence: TX 1177) | |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2007-07-08 |