| NPI | 1679909329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: ID LCPC-6859) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: ID LPC-5185) |
| Enumeration Date | 2013-09-25 |
| Last Update Date | 2020-05-11 |