| NPI | 1295962439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NM 0150061) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0111731) |
| Enumeration Date | 2009-06-15 |
| Last Update Date | 2013-03-04 |