| NPI | 1477077675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CO LPC.0017450) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CO ACD.0001357) |
| Enumeration Date | 2017-07-28 |
| Last Update Date | 2021-11-16 |