| NPI | 1083776256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: ID LCPC-3444) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: ID LPC-2797) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2023-07-03 |