| NPI | 1194531574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 10002624) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA LMHC10002624) |
| Enumeration Date | 2024-12-10 |
| Last Update Date | 2024-12-10 |