| NPI | 1306226428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MT BBH-LCPC-LIC-58851) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0014931) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2025-10-03 |