| NPI | 1568878239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-8676) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ LPC-18664) |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2026-08-10 |