| NPI | 1790302768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0023097) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-9689) |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2026-01-27 |