| NPI | 1063841856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ID LCPC-7041) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ID LPC-5447) |
| Enumeration Date | 2013-11-02 |
| Last Update Date | 2020-05-12 |