| NPI | 1558564468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 843) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 8213) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2011-11-23 |