| NPI | 1811164445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 0680000389) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: VT 068-0000389) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2011-06-24 |