| NPI | 1063847713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC-9020) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MT 4484) |
| Enumeration Date | 2013-09-12 |
| Last Update Date | 2025-03-18 |