| NPI | 1003966136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OR C1301) |
| Additional Taxonomies | 103TS0200X Psychologist School |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2007-10-02 |