| NPI | 1457498164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CT 001854) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 4608) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2013-08-09 |