| NPI | 1609176874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC6582) |
| Additional Taxonomies | 101YP2500X Counselor, Professional |
| Enumeration Date | 2010-10-21 |
| Last Update Date | 2025-04-11 |