| NPI | 1013940642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 0151831) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ 11071) |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2015-01-09 |