| NPI | 1245972991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MT BBH-LCPC-LIC-57279) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MT BBH-PCLC-LIC-49247) |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2025-03-05 |