| NPI | 1639599327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 6193) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 91525) |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2025-09-30 |