| NPI | 1780851881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC5513) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH7190) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2014-12-21 |