| NPI | 1134561764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0012652) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NE 3055) |
| 101YM0800X Counselor, Mental Health (Licence: NE 4085) | |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2026-02-13 |