| NPI | 1962714477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: SC LPC4063) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: SC LPC4063) |
| 101YP2500X Counselor, Professional (Licence: SC 4063) | |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2026-07-07 |