| NPI | 1740438134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ME XL3400) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ME XL3400) |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2008-08-28 |