| 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 |