| NPI | 1710592142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LPC-7594) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-7594) |
| 101YS0200X Counselor, School (Licence: ID 611935432) | |
| Enumeration Date | 2020-09-11 |
| Last Update Date | 2024-07-25 |