| NPI | 1386707842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 1047) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 970) |
| 101YM0800X Counselor Mental Health (Licence: NE 1570) | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2013-04-03 |