| NPI | 1730485707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C2972) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR C2972) |
| 101YM0800X Counselor, Mental Health (Licence: OR C2972) | |
| Enumeration Date | 2011-02-08 |
| Last Update Date | 2012-09-13 |