| NPI | 1396976890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: MD LCPC) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 7221) |
| 101YP2500X Counselor, Professional (Licence: NC 7221) | |
| Enumeration Date | 2009-07-31 |
| Last Update Date | 2018-04-20 |