| NPI | 1417357906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NE 2963) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC14194) |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2025-10-22 |