| NPI | 1558751537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-7589) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NM 0170091) |
| Enumeration Date | 2015-01-29 |
| Last Update Date | 2022-04-22 |