| NPI | 1497156590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC-8834) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: LPC-5619) |
| Enumeration Date | 2014-09-08 |
| Last Update Date | 2024-01-18 |