| NPI | 1679915920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC-5409) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ID LPC-3636) |
| Enumeration Date | 2013-07-26 |
| Last Update Date | 2023-12-04 |