| NPI | 1790877090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA LMHC10002806) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 5935490-6009) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2025-06-02 |