| NPI | 1992849178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 999) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 3149) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2012-06-14 |