| NPI | 1821372087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MS 1402) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: MS 187291) |
| Enumeration Date | 2011-10-06 |
| Last Update Date | 2011-10-06 |