| NPI | 1457365058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 914) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 00813) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2016-09-29 |