| NPI | 1831312180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MO 2003030514) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MO 2003030514) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2007-07-08 |