| NPI | 1750669164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NE 1661) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NE 3212) |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2011-08-02 |