| NPI | 1760993927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LA 8543) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA LPC016807) |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2026-05-25 |