| NPI | 1912282229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NY 004855) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NV CP5786-R) |
| 101YM0800X Counselor, Mental Health (Licence: FL TPMC956) | |
| Enumeration Date | 2011-10-18 |
| Last Update Date | 2025-11-24 |