| NPI | 1639326549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 6970) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 00099107) |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2008-08-21 |