| NPI | 1659362341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD 06416) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WV CP00938909) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2007-07-08 |