| NPI | 1316671597 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC15607) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: DC LGPC200012661) |
| Enumeration Date | 2022-07-13 |
| Last Update Date | 2026-06-01 |