| NPI | 1396048013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NV CI0020) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NV CP0073) |
| Enumeration Date | 2010-12-20 |
| Last Update Date | 2014-01-23 |