| NPI | 1891886610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: DE PC-0000288) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: DE PC 0000288) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2009-06-26 |