| NPI | 1528194495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ID LSW-571) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-289) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2007-07-08 |