| NPI | 1205121134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 1663) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 4267) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2017-07-31 |