| NPI | 1578676813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LCPC 364) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA 010068) |
| 101YM0800X Counselor, Mental Health (Licence: WA 60821655) | |
| 101YP2500X Counselor, Professional (Licence: UT 123387771-6004) | |
| 101YP2500X Counselor, Professional (Licence: ID 364) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2025-01-17 |