| NPI | 1790744845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 135) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 105) |
| Enumeration Date | 2006-03-18 |
| Last Update Date | 2013-09-30 |