| NPI | 1124257159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 2675) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NE 1431) |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2009-07-13 |