| NPI | 1962885319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-7232) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ID LPC-5881) |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2026-06-22 |