| NPI | 1457309387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA 003153) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2007-12-26 |