| NPI | 1700948452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: CA 46154) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2009-12-28 |