| NPI | 1447815345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MT BBH-LCPC-LIC-43126) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2022-04-05 |