| NPI | 1982285748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LPC-4749) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM LPCC-CCMH0223451) |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2024-08-18 |