| NPI | 1427019116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TN 1846) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 5245) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2007-07-09 |