| NPI | 1336308709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: ME CC3955) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: ME CC3955) |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2020-10-14 |