| NPI | 1093939985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 783) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 2642) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2018-11-19 |