| NPI | 1982131314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-9688) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC-6558) |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2024-04-09 |