| NPI | 1043704414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-7961) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID 6960) |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2023-12-04 |