| NPI | 1396472767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C7144) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-21209) |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2025-09-18 |