| NPI | 1821340977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA LPCC4199) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: WI LPC8031-125) |
| 101YP2500X Counselor, Professional (Licence: CO LPC16308) | |
| 101YP2500X Counselor, Professional (Licence: KS LCPC02928) | |
| 101YP2500X Counselor, Professional (Licence: IN LMHC39003814A) | |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2021-10-26 |