| NPI | 1295701696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NE LMHP2211) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NE LCSW995) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2007-07-09 |