| NPI | 1487716445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: UT 319016-6004) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ID LCPC-257) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2007-07-08 |