| NPI | 1881723948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR LPC C3060) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MT 867 - LCPC) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2013-05-27 |