| NPI | 1245840446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC012471) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NH 4686) |
| 101YM0800X Counselor, Mental Health (Licence: VT 068.0135774) | |
| Enumeration Date | 2020-08-03 |
| Last Update Date | 2026-03-23 |