| NPI | 1144462540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 1104) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 8813) |
| 101YM0800X Counselor, Mental Health (Licence: NE 3822) | |
| Enumeration Date | 2009-03-31 |
| Last Update Date | 2014-02-24 |