| NPI | 1497108872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 6240769-6004) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 13317) |
| 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00936800) | |
| 101YM0800X Counselor, Mental Health (Licence: NY 014689) | |
| 101YM0800X Counselor, Mental Health (Licence: MA LMHC10003114) | |
| Enumeration Date | 2016-07-20 |
| Last Update Date | 2024-11-11 |