| NPI | 1548617392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 2076) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 10868) |
| Enumeration Date | 2016-05-23 |
| Last Update Date | 2019-07-08 |