| NPI | 1962053314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MT BBH-LCPC-LIC-55424) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MT BBH-PCLC-LIC-38594) |
| Enumeration Date | 2019-09-26 |
| Last Update Date | 2023-04-25 |