| NPI | 1952646267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 71573) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 9604) |
| Enumeration Date | 2012-11-28 |
| Last Update Date | 2014-01-07 |