| NPI | 1518269695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 2010037184) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: MO 2010037184) |
| Enumeration Date | 2010-11-23 |
| Last Update Date | 2010-11-23 |