| NPI | 1578954707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 10460) |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2016-08-26 |