| NPI | 1639354137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 9855) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WY PMFT-233) |
| Enumeration Date | 2008-01-02 |
| Last Update Date | 2010-01-28 |