| NPI | 1376965509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC-6743) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC3941) |
| Enumeration Date | 2014-01-07 |
| Last Update Date | 2021-07-02 |