| NPI | 1164860102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 5154) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 9988) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2020-05-26 |