| NPI | 1174973374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC-8037) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C9964) |
| Enumeration Date | 2016-06-18 |
| Last Update Date | 2025-11-07 |