| NPI | 1053457861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AL 3085) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2026-03-11 |