| NPI | 1265801039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 551) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 10661) |
| 101YM0800X Counselor, Mental Health (Licence: NE 4860) | |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2017-05-10 |