| NPI | 1679686414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: AR P9508019) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: TX 12091) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2007-07-08 |