| NPI | 1891085627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 068.0000373) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 5544) |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2012-06-21 |