| NPI | 1467996157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 010210) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: GA APC005562) |
| 101YP2500X Counselor, Professional (Licence: GA LPC010993) | |
| Enumeration Date | 2016-12-14 |
| Last Update Date | 2020-03-24 |