| NPI | 1669135687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC.0019420) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 016211) |
| Enumeration Date | 2021-10-17 |
| Last Update Date | 2025-10-03 |