| NPI | 1992017354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LPC-4387) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ID LPC-4387) |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2010-07-13 |