| NPI | 1124084157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 359) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 10) |
| 1041C0700X Social Worker, Clinical (Licence: NE 145) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2010-11-22 |