| NPI | 1174793368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AK LPC-541) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-164) |
| Enumeration Date | 2008-03-04 |
| Last Update Date | 2008-03-04 |