| NPI | 1053638791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| 101YS0200X Counselor School | |
| Enumeration Date | 2010-04-20 |
| Last Update Date | 2010-04-20 |