| NPI | 1689911307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 2173) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YM0800X Counselor Mental Health (Licence: NE 9849) | |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2019-05-15 |