| NPI | 1760229918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AK 235791) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GU LPC-141) |
| 101YM0800X Counselor, Mental Health (Licence: GU LMHC-018) | |
| Enumeration Date | 2024-07-13 |
| Last Update Date | 2026-02-12 |