| NPI | 1376865287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT BBH-LCPC-LIC-72842) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0012648) |
| Enumeration Date | 2010-02-18 |
| Last Update Date | 2024-12-09 |