| NPI | 1659469963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 2522) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NE 1371) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2007-07-08 |