| NPI | 1932610128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 2017035078) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: KS LCPC04079) |
| 101YP2500X Counselor, Professional (Licence: FL TPMC5870) | |
| 101YP2500X Counselor, Professional (Licence: CA 22349) | |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2026-06-18 |