| NPI | 1760677645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MT 1331) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2010-09-14 |