| 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 |