| NPI | 1093982761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 3551) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NE 1782) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2011-09-27 |