| NPI | 1013358217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL IMH217224) |
| Additional Taxonomies | 247200000X Technician, Other |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2021-10-20 |