| NPI | 1568258697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: DC LGPC200001923) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37AC00859400) |
| Enumeration Date | 2025-04-16 |
| Last Update Date | 2025-04-16 |