| NPI | 1225204159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 5013238-6004) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-8164) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2025-09-12 |