| NPI | 1336138056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: IN 39000103A) |
| Additional Taxonomies | 101YS0200X Counselor School (Licence: IN 750482) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2007-07-08 |