| NPI | 1952619124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: NE 1437) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NE 9185) |
| Enumeration Date | 2010-09-21 |
| Last Update Date | 2019-06-03 |