| NPI | 1215478292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC LPC# 11006) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC NCC# 336016) |
| Enumeration Date | 2017-03-10 |
| Last Update Date | 2017-03-10 |