| NPI | 1053510453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC005616) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701014406) |
| 101YP2500X Counselor, Professional (Licence: MI 6401224905) | |
| 101YM0800X Counselor, Mental Health (Licence: FL MH24930) | |
| 101YP2500X Counselor, Professional (Licence: CO LPC0021839) | |
| 101YP2500X Counselor, Professional (Licence: AZ LPC23668) | |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2025-09-11 |