| NPI | 1437452497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MD LC3029) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: DC PRC14112) |
| Enumeration Date | 2010-12-14 |
| Last Update Date | 2010-12-14 |