| NPI | 1174628465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 000308) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: MO 01317) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2007-07-08 |