| NPI | 1538053038 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA LMHC10003684) | 
| Additional Taxonomies | 101200000X Drama Therapist (Licence: MA RDT891) | 
| Enumeration Date | 2025-06-07 | 
| Last Update Date | 2025-06-07 |