| NPI | 1588709745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MA 3567) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 3567) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2007-07-08 |