| NPI | 1366223620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AL ALC04620) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID 8081111) |
| 101YM0800X Counselor, Mental Health (Licence: FL TPMC7760) | |
| 101YM0800X Counselor, Mental Health (Licence: VT 068.0137202TELE) | |
| 101YP2500X Counselor, Professional (Licence: AL LPC05899) | |
| Enumeration Date | 2023-10-11 |
| Last Update Date | 2026-05-20 |