| NPI | 1679996342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 1426) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 9963) |
| 101YM0800X Counselor, Mental Health (Licence: NE 4506) | |
| 103T00000X Psychologist (Licence: NE 4506) | |
| Enumeration Date | 2014-01-30 |
| Last Update Date | 2020-11-17 |