| NPI | 1841593241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MO 2010040559) |
| Enumeration Date | 2010-12-08 |
| Last Update Date | 2011-12-14 |