| NPI | 1467135897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CT 7454) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: 7454) |
| Enumeration Date | 2023-08-11 |
| Last Update Date | 2025-05-20 |