| NPI | 1588061022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0022649) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KY 1329) |
| Enumeration Date | 2014-11-27 |
| Last Update Date | 2025-12-16 |