| NPI | 1093080632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 4587) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LA LPC 4587) |
| Enumeration Date | 2012-03-15 |
| Last Update Date | 2013-07-31 |