| NPI | 1154609998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-7528) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID 4858) |
| 101YM0800X Counselor, Mental Health (Licence: ID 4858) | |
| 101Y00000X Counselor (Licence: ID 4858) | |
| 101YP2500X Counselor, Professional (Licence: ID LCPC-7528) | |
| 101YP2500X Counselor, Professional (Licence: ID 4858) | |
| 102L00000X Psychoanalyst (Licence: ID 4858) | |
| Enumeration Date | 2011-07-27 |
| Last Update Date | 2022-06-08 |