| NPI | 1336394287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0011730) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MT 1388 LCPC) |
| Enumeration Date | 2008-11-19 |
| Last Update Date | 2019-08-23 |