| NPI | 1679005953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC-8745) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0012587) |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2023-01-12 |