| NPI | 1912063330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CT 001361) |
| Additional Taxonomies | 103TS0200X Psychologist School |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2007-07-26 |