| NPI | 1376712836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 3242 LPC;0151 LCAS) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: SD 3242;0151) |
| Enumeration Date | 2008-02-28 |
| Last Update Date | 2008-02-28 |