| NPI | 1295142214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 10293) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 5079) |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2018-03-28 |