| NPI | 1588857403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 17145) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 004337) |
| 101YP2500X Counselor, Professional (Licence: PR 2579) | |
| 101YP2500X Counselor, Professional (Licence: SC 7942) | |
| 101YM0800X Counselor, Mental Health (Licence: FL MH23710) | |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2025-11-03 |