| NPI | 1770094096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA PC011794) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00915700) |
| 101YM0800X Counselor, Mental Health | |
| 101YM0800X Counselor, Mental Health (Licence: TX 83410) | |
| Enumeration Date | 2017-10-13 |
| Last Update Date | 2025-03-25 |