| NPI | 1710246574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 15574) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LCPC012444) |
| 101YM0800X Counselor, Mental Health (Licence: ID LCPC8600) | |
| 101YP1600X Counselor, Pastoral | |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2026-04-21 |