| NPI | 1205144409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MI 6401011523) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MI 6401011523) |
| Enumeration Date | 2010-09-22 |
| Last Update Date | 2010-09-22 |