| NPI | 1619090446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH9849) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.000532) |
| Enumeration Date | 2007-04-08 |
| Last Update Date | 2009-08-26 |