| NPI | 1508057928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO lpc-12464) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0096661) |
| Enumeration Date | 2007-08-09 |
| Last Update Date | 2015-06-12 |