| NPI | 1902377641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH23984) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA LMHC11533) |
| 101YM0800X Counselor, Mental Health (Licence: VT 068.0118746) | |
| Enumeration Date | 2018-12-06 |
| Last Update Date | 2025-05-01 |