| NPI | 1225413545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MT BBH-LCPC-LIC-12308) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MT SWP-LCPC-LIC-12308) |
| 101YP2500X Counselor, Professional (Licence: MT SWP-LCPC-LIC-12308) | |
| 106H00000X Marriage & Family Therapist (Licence: MT BBH-LMFT-LIC-37538) | |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2021-03-07 |