| NPI | 1730274291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MO 003847) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MO 2001013760) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2007-07-08 |