| NPI | 1003919283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH 4746) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: FL MH 4746) |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2008-06-30 |