| NPI | 1922131127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 1244) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 1243) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2013-02-06 |