| NPI | 1912043415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IA 02512) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IA 02512) |
| 101YP2500X Counselor, Professional (Licence: IA 02512) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2013-06-06 |