| NPI | 1154083897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MI 6401223256) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: RI MHC01319) |
| 101YM0800X Counselor, Mental Health (Licence: UT 10460707-6004) | |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0013400) | |
| Enumeration Date | 2021-10-11 |
| Last Update Date | 2023-09-05 |