| NPI | 1497848550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 273R00000X Psychiatric Unit |
| 282N00000X General Acute Care Hospital | |
| 101YP2500X Counselor, Professional | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2014-10-22 |