| NPI | 1669721270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: OR 134555) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2013-05-16 |