| NPI | 1477215598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA LMHC10003754) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA LPC013786) |
| Enumeration Date | 2021-10-06 |
| Last Update Date | 2026-05-30 |