| NPI | 1952759342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 15311) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0701015964) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2026-03-19 |