| NPI | 1326036492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 593) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NE 1475) |
| 101YP2500X Counselor Professional (Licence: NE 935) | |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2011-12-16 |