| NPI | 1407990476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NC 5416) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 5416) |
| 101YP2500X Counselor, Professional (Licence: NC 5416) | |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2007-07-08 |