| NPI | 1518176718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 6763) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: RI 00295) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2010-01-26 |