| NPI | 1588800882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ND 569-12-15-06-190) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: ND 569-12-15-06-190) |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2016-01-06 |