| NPI | 1760707798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA 000888) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: PA 000888) |
| Enumeration Date | 2010-04-01 |
| Last Update Date | 2011-06-30 |