| NPI | 1821224353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LCP2438) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 6910) |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2012-10-01 |