| NPI | 1265205025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NV CP55929-R) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OH E.2404615) |
| Enumeration Date | 2023-11-03 |
| Last Update Date | 2026-02-14 |