| NPI | 1760626501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AL 2757) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TN 1853) |
| Enumeration Date | 2009-04-23 |
| Last Update Date | 2009-08-17 |