| NPI | 1669910790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC-6488) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ID LCPC-6488) |
| 101YM0800X Counselor, Mental Health (Licence: ID LCPC-6488) | |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2021-12-03 |