| NPI | 1992071062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 1720) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 9607) |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2022-02-17 |