| NPI | 1629936943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LGP17496) |
| Enumeration Date | 2026-01-14 |
| Last Update Date | 2026-03-06 |