| NPI | 1942796651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CT 005818) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-8489) |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2023-07-24 |