| NPI | 1790857811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 2275) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 563) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2012-05-16 |