| NPI | 1497361661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ME CC6175) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.012799) |
| 101YP2500X Counselor, Professional (Licence: MA LMHC10001441) | |
| Enumeration Date | 2020-09-22 |
| Last Update Date | 2024-12-11 |