| NPI | 1225382567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC 11394) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: UT 279614-6004) |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2015-04-21 |