| NPI | 1841912706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC15798) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NJ 37PC01071000) |
| 101Y00000X Counselor (Licence: DC PRC200002033) | |
| Enumeration Date | 2022-09-16 |
| Last Update Date | 2025-01-02 |