| NPI | 1669699351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NC 4756) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 4756) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2025-09-11 |