| NPI | 1073003513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NH LCMHC2344) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA LMHC9626) |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2024-12-10 |