| NPI | 1710425087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CT 3078) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH20181) |
| 101YM0800X Counselor, Mental Health (Licence: MA 11153) | |
| Enumeration Date | 2017-02-07 |
| Last Update Date | 2024-09-03 |