| NPI | 1336550110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM 0160471) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-10656) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2014-05-14 |