| NPI | 1407578800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT BBH-LCPC-LIC-55522) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AK 196757) |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2025-09-29 |