| NPI | 1295911204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YS0200X Counselor School (Licence: NC 2642) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 2642) |
| 101YM0800X Counselor Mental Health (Licence: NC 2642) | |
| 101YP2500X Counselor Professional (Licence: NC 2642) | |
| Enumeration Date | 2008-01-21 |
| Last Update Date | 2010-06-15 |