| NPI | 1760452213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NE LMHP2794) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE LADC474) |
| 101Y00000X Counselor (Licence: NE LIMHP 13) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2008-11-19 |