| NPI | 1861775561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MA 12787) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: RI MHC01167) |
| 101YP2500X Counselor, Professional (Licence: CT 002101) | |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2025-09-10 |