| NPI | 1518953405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: SD LPCMH2089) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: SD LPC985) |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2007-11-16 |