| NPI | 1740309566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CT 000326) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CT 000326) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2013-05-28 |