| NPI | 1558790964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 10063) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NE 58) |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2013-12-06 |