| NPI | 1134338726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MT 241) |
| Additional Taxonomies | 101YS0200X Counselor School |
| 103TS0200X Psychologist School | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2007-07-08 |