| NPI | 1124170147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DC LC302104) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD 07303) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2026-02-13 |