| NPI | 1780711887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 6787) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MA 1673) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2016-06-14 |