| NPI | 1073876496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 5560) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2015-11-06 |