| NPI | 1932239027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CO 204504) |
| 167G00000X Licensed Psychiatric Technician (Licence: CO 4637) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2012-04-27 |