| NPI | 1811174568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC6385) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NH 495) |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2015-06-01 |