| NPI | 1487973178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 101Y00000X Counselor | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2010-05-20 |
| Last Update Date | 2012-12-18 |