| NPI | 1275161341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH17862) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VT 068.0136273TELE) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2026-07-29 |