| NPI | 1194863662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: 19292) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 19292) |
| Enumeration Date | 2007-02-04 |
| Last Update Date | 2025-04-15 |