| NPI | 1376554840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 304) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 1689) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2012-06-04 |