| NPI | 1003055500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 005308) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC006295) |
| 101YP2500X Counselor, Professional (Licence: NC 8823) | |
| Enumeration Date | 2009-02-07 |
| Last Update Date | 2014-10-02 |