| NPI | 1710371240 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 8282) | 
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 8282) | 
| Enumeration Date | 2015-03-23 | 
| Last Update Date | 2025-07-16 |