| NPI | 1720638844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 12012) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NE P-1718) |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2019-09-19 |