| NPI | 1013102474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC003420) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E2829) |
| 101YM0800X Counselor, Mental Health (Licence: NY 3497-1) | |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2007-09-10 |