| NPI | 1922645449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NH 5548) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA LMHC10002845) |
| Enumeration Date | 2019-12-03 |
| Last Update Date | 2026-05-27 |