| NPI | 1073881561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC-5455) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC-4825) |
| 101YP2500X Counselor, Professional (Licence: TX 88523) | |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2023-03-01 |