| NPI | 1134538101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA LMHC10002298) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YM0800X Counselor, Mental Health (Licence: MN LPCC1379) | |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2024-08-05 |