| NPI | 1326354911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: GA 005172) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NC 241956) |
| 101YM0800X Counselor, Mental Health (Licence: UT 9262334-6004) | |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2015-02-16 |