| NPI | 1427162676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 10653) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VT 068.0099603) |
| 101YM0800X Counselor, Mental Health (Licence: NY 002890-1) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2014-10-07 |