| NPI | 1043527302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MT BBH-LCPC-LIC-57158) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID lcpc-4866) |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2024-02-12 |