| NPI | 1780800060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MA 1409) |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2007-07-08 |