| NPI | 1619088374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 328) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 2151) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2008-12-05 |