| NPI | 1760667232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 77) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NE P-316) |
| 101YM0800X Counselor Mental Health (Licence: NE 2663) | |
| Enumeration Date | 2008-01-03 |
| Last Update Date | 2008-01-03 |