| NPI | 1801082284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 3776) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NE 1878) |
| Enumeration Date | 2007-09-19 |
| Last Update Date | 2010-09-14 |