| NPI | 1508908484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ID LPC-3339) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: ID LPC-3339) |
| 101YP2500X Counselor Professional (Licence: ID LPC-3339) | |
| 101YS0200X Counselor School (Licence: ID LPC-3339) | |
| 106H00000X Marriage & Family Therapist (Licence: ID LPC-3339) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-07-08 |