| NPI | 1679263685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC16383) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: DC PRC200012556) |
| 101YP2500X Counselor, Professional (Licence: VA 0701014810) | |
| Enumeration Date | 2023-05-11 |
| Last Update Date | 2025-10-31 |