| NPI | 1891844239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: HI MHC 242) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701003945) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2011-05-02 |