| NPI | 1881838282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: ID LPC-9530) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: ID LPC-9530) |
| 101YP2500X Counselor Professional (Licence: ID LPC-9530) | |
| 106H00000X Marriage & Family Therapist (Licence: ID LPC-9530) | |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2023-06-01 |