| NPI | 1730284530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH12288) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: ID LPC3487) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2015-11-24 |