| NPI | 1114253176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC LPC #6484) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR LPC #C0695) |
| Enumeration Date | 2009-10-27 |
| Last Update Date | 2009-10-30 |