| NPI | 1770247298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 11353007-6004) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 180.013648) |
| 101YP2500X Counselor, Professional (Licence: IL 180.013648) | |
| Enumeration Date | 2021-10-30 |
| Last Update Date | 2026-04-20 |