| NPI | 1194492611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VT 097.0134209) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CT 4737) |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2026-03-30 |