| NPI | 1043833874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC12430) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IA 128945) |
| 101YM0800X Counselor, Mental Health (Licence: FL TPMC5622) | |
| 101YP2500X Counselor, Professional (Licence: PA PC018018) | |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2025-01-15 |