| NPI | 1497419485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC-8331204) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-8331204) |
| Enumeration Date | 2021-10-26 |
| Last Update Date | 2025-07-10 |