| NPI | 1295169704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 989) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 3779) |
| 101YP2500X Counselor, Professional (Licence: NE 1880) | |
| Enumeration Date | 2013-09-03 |
| Last Update Date | 2013-09-03 |