| NPI | 1619016748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 1919) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NE 1114) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2007-07-08 |