| NPI | 1275967895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-6304) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC-5312) |
| 101YP2500X Counselor, Professional (Licence: ID LPC-5312) | |
| Enumeration Date | 2013-08-30 |
| Last Update Date | 2024-03-07 |