| NPI | 1003983636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: NC LPC 10930) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: NC LPC 10930) |
| 101YP2500X Counselor Professional (Licence: NC 10930) | |
| 106H00000X Marriage & Family Therapist (Licence: CA MFC39143) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2022-07-21 |