| NPI | 1225230097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM 0119891) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 9113) |
| 101YM0800X Counselor, Mental Health (Licence: NC 9113) | |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2012-10-15 |