| NPI | 1518367192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH15061) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA LMHC10003828) |
| Enumeration Date | 2014-09-02 |
| Last Update Date | 2025-05-28 |