| NPI | 1730354895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 977) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 3117) |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2008-04-29 |