| NPI | 1366594020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NM 2168) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: NM 267076) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2016-03-03 |