| NPI | 1205414927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 0701010290) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KY 307017) |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2026-05-18 |