| NPI | 1871883512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 4463) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NE 1549) |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2014-08-12 |