| NPI | 1740865328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-22156) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC LCMHC-22788) |
| Enumeration Date | 2021-03-15 |
| Last Update Date | 2026-06-01 |