| NPI | 1710722475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: FL MH15733) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401223506) |
| 101YM0800X Counselor, Mental Health (Licence: NY 014992) | |
| Enumeration Date | 2024-06-26 |
| Last Update Date | 2025-04-02 |