| NPI | 1194124180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-8643) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC-0015208) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2014-08-15 |
| Last Update Date | 2022-07-07 |