| NPI | 1073070124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-9160) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC-7194) |
| Enumeration Date | 2019-02-25 |
| Last Update Date | 2022-11-18 |