| NPI | 1568795680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC2263) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LC2263) |
| Enumeration Date | 2009-09-08 |
| Last Update Date | 2013-02-01 |