| NPI | 1407005416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DC LC300557) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD 13575) |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2013-02-27 |