| NPI | 1962573659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NH 642) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ME CC2999) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2017-01-23 |