| NPI | 1962685420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 692) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 3133) |
| 101YP2500X Counselor, Professional (Licence: NE 1627) | |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2015-03-17 |