| NPI | 1063834844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 2856) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 11578) |
| 101YM0800X Counselor, Mental Health (Licence: CA 7905) | |
| Enumeration Date | 2014-01-13 |
| Last Update Date | 2026-06-15 |