| NPI | 1710431242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: ID LCPC-7255) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: ID LPC6277) |
| Enumeration Date | 2016-08-12 |
| Last Update Date | 2024-04-16 |