| NPI | 1619176351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 3378) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE P-629) |
| 101YM0800X Counselor, Mental Health (Licence: NE 8149) | |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2008-08-18 |