| NPI | 1750803110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ID COUI-6369) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ID LCPC-8678) |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2024-01-09 |