| NPI | 1366756181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-4569) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC4569) |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2016-06-15 |