| NPI | 1922173095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AL 608) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AL L41) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2007-07-08 |