| NPI | 1003192451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH15909) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2020-10-27 |