| NPI | 1205992823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC140) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-140) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2010-09-14 |