| NPI | 1871655803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 5312) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 5312) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2008-04-09 |