| NPI | 1922445253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 581) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 5225) |
| 101YM0800X Counselor, Mental Health (Licence: NE 11205) | |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2018-11-12 |