| NPI | 1467720060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TN LPC3417) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA APC003225) |
| Enumeration Date | 2011-12-09 |
| Last Update Date | 2015-06-12 |