| NPI | 1215362009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ID LCPC-6320) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ID LPC-5279) |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2023-08-17 |