| NPI | 1003107129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 3484) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NE 3983) |
| Enumeration Date | 2011-04-23 |
| Last Update Date | 2024-01-19 |