| NPI | 1861697856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 101Y00000X Counselor (Licence: SC 7981) |
| 101YM0800X Counselor, Mental Health (Licence: SC 7981) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2026-04-16 |