| NPI | 1467510362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701003254) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 3450) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2007-07-08 |