| NPI | 1437658697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 75222) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AK 231648) |
| 101YM0800X Counselor, Mental Health (Licence: FL TPMC7159) | |
| 101YM0800X Counselor, Mental Health (Licence: NY 015778) | |
| Enumeration Date | 2018-02-02 |
| Last Update Date | 2026-05-30 |