| NPI | 1275085433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: ID LCPC-6361) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: ID LPC-6027) |
| Enumeration Date | 2016-11-03 |
| Last Update Date | 2021-05-10 |