| NPI | 1356785984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NV CP0075) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NV IP130215001) |
| 101YP2500X Counselor, Professional (Licence: AZ LPC-1241) | |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2013-07-01 |