| NPI | 1164303749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: IL 180016287) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0022503) |
| 101YM0800X Counselor, Mental Health (Licence: TX 99926) | |
| Enumeration Date | 2025-09-10 |
| Last Update Date | 2025-09-10 |