| NPI | 1609855170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 0001) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 0005) |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2007-07-08 |