| NPI | 1972088110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C6051) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-23107) |
| Enumeration Date | 2018-10-03 |
| Last Update Date | 2025-11-17 |