| NPI | 1306372115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH16565) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E.1901171) |
| 101YM0800X Counselor, Mental Health (Licence: VA 701009104) | |
| 101YM0800X Counselor, Mental Health (Licence: TX 94706) | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2025-08-25 |