| NPI | 1053509059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: VT 068-0000704) |
| Additional Taxonomies | 101YS0200X Counselor School |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2007-10-15 |