| NPI | 1639253040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 2141) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NE 95) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2013-03-01 |