| NPI | 1396799920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NH 250) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NH 443) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2015-11-23 |