| NPI | 1487814075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NC 8386) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NY 00004531) |
| Enumeration Date | 2008-06-17 |
| Last Update Date | 2011-06-08 |