| NPI | 1740639293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO 0015913) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180016766) |
| 101YM0800X Counselor, Mental Health (Licence: MO 2015043556) | |
| 101YM0800X Counselor, Mental Health (Licence: TX 92677) | |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2026-08-26 |