| NPI | 1992943385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LCPC-9211) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ID 6366) |
| 101YM0800X Counselor, Mental Health (Licence: WA 60022726) | |
| Enumeration Date | 2009-01-23 |
| Last Update Date | 2025-04-30 |