| NPI | 1912105354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL mh9090) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA LPC004291) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2007-07-08 |