| NPI | 1942454350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 481) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 001052) |
| 101YM0800X Counselor, Mental Health (Licence: NE 3132) | |
| 101YM0800X Counselor, Mental Health (Licence: NE 1626) | |
| Enumeration Date | 2008-11-12 |
| Last Update Date | 2010-06-18 |