| NPI | 1063658813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 4565) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO 4565) |
| 101YP2500X Counselor, Professional (Licence: CO 4565) | |
| Enumeration Date | 2008-12-29 |
| Last Update Date | 2008-12-29 |