| NPI | 1346917432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: DC PRC200001572) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37AC00509500) |
| Enumeration Date | 2021-08-26 |
| Last Update Date | 2023-08-02 |