| NPI | 1972701647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE LIMHP-705) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE LMHP-3150) |
| 101YP2500X Counselor, Professional (Licence: NE CPC-1670) | |
| Enumeration Date | 2007-07-04 |
| Last Update Date | 2010-12-13 |