| NPI | 1841689627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 1535) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 4538) |
| Enumeration Date | 2015-01-15 |
| Last Update Date | 2016-10-07 |