| NPI | 1447345970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC 7259) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: TX 19380) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2008-12-20 |