| NPI | 1326059072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: ID 5698) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NE 406) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2015-11-18 |