| NPI | 1447398680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 1182) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 413) |
| 101YP2500X Counselor, Professional (Licence: NE 411) | |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2013-11-21 |