| NPI | 1033545082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SD 30550) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0011682) |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2025-01-17 |