| NPI | 1639404205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YM0800X Counselor Mental Health | |
| 101YS0200X Counselor School | |
| Enumeration Date | 2009-10-14 |
| Last Update Date | 2009-10-14 |