| NPI | 1518161827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-4441) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ID LCPC-4441) |
| Enumeration Date | 2007-06-12 |
| Last Update Date | 2020-04-08 |