| NPI | 1982285748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-8321282) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA LPCC-20894) |
| 101YM0800X Counselor, Mental Health (Licence: AZ LPC-23359) | |
| 101YM0800X Counselor, Mental Health (Licence: NM LPCC-CCMH0223451) | |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2025-10-21 |