| NPI | 1477961753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-7150) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 127972386004) |
| 101YM0800X Counselor, Mental Health (Licence: FL TMPC1034) | |
| 101YM0800X Counselor, Mental Health (Licence: ID LPC-5602) | |
| Enumeration Date | 2014-07-30 |
| Last Update Date | 2022-08-01 |