| NPI | 1346652401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC6463) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC5583) |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2018-03-17 |