| NPI | 1114335478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-6635) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC-5600) |
| Enumeration Date | 2014-07-30 |
| Last Update Date | 2023-01-19 |