| NPI | 1710927629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NE LMHP 1682) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE CPC 1018) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2023-05-25 |