| NPI | 1720575780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NV CP5003) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH61413920) |
| 101YP2500X Counselor, Professional (Licence: ID 7161179) | |
| 101YP2500X Counselor, Professional (Licence: NM CTB-2024-0718) | |
| 101YP2500X Counselor, Professional (Licence: NV CP5003) | |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2026-03-26 |