| NPI | 1710210661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NE 2083) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 4282) |
| 101YM0800X Counselor, Mental Health (Licence: IA 001280) | |
| Enumeration Date | 2009-09-10 |
| Last Update Date | 2015-03-30 |