| NPI | 1861877060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC LPC.0018178) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 8737) |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2022-06-29 |