| NPI | 1639302706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM 0158941) |
| Additional Taxonomies | 174400000X Specialist |
| 101YM0800X Counselor, Mental Health (Licence: NM 0158941) | |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2014-07-17 |