| NPI | 1952173619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AL ALC02367) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AL LPC05619) |
| Enumeration Date | 2023-10-26 |
| Last Update Date | 2025-07-11 |