| NPI | 1487983177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ME XL3551) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ME cc3876) |
| Enumeration Date | 2009-12-09 |
| Last Update Date | 2012-11-20 |