| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
|
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health |
| 103TC2200X Psychologist, Clinical Child & Adolescent |
| 103TF0200X Psychologist, Forensic |
| 103TP2701X Psychologist, Group Psychotherapy |
| 103TR0400X Psychologist, Rehabilitation |
| 1041C0700X Social Worker, Clinical |
| 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2021-08-11 |
| Last Update Date | 2021-08-11 |