| NPI | 1609173459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 0573) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39000161a) |
| Enumeration Date | 2011-02-14 |
| Last Update Date | 2011-02-14 |