| NPI | 1942840244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CT 4570) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 11955) |
| 103TC1900X Psychologist, Counseling (Licence: TX 73872) | |
| Enumeration Date | 2020-01-14 |
| Last Update Date | 2021-10-26 |