| NPI | 1467115428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC-10257) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID 8278) |
| Enumeration Date | 2021-10-18 |
| Last Update Date | 2026-03-09 |