| NPI | 1104368992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT BBH-LCPC-LIC-19497) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2016-11-09 |
| Last Update Date | 2021-10-17 |