| NPI | 1285904722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701002516) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: VA 0803000036) |
| Enumeration Date | 2011-12-30 |
| Last Update Date | 2011-12-30 |