| NPI | 1609962273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 4040) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 12796) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-07-08 |