| NPI | 1366756371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 4995) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IA 109887) |
| 101YM0800X Counselor Mental Health (Licence: NE 9003) | |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2024-06-21 |