| NPI | 1245393461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE LIMHP 794) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE LMHP1482) |
| 101YP2500X Counselor, Professional (Licence: NE 938) | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2016-12-16 |