| NPI | 1669567285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA none required) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: none required) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2007-07-08 |