| NPI | 1558750570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 1921) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 4902) |
| 101YM0800X Counselor, Mental Health (Licence: NE 10466) | |
| Enumeration Date | 2015-01-14 |
| Last Update Date | 2018-03-20 |