| NPI | 1013560382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH16892) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL MH16892) |
| 101YP2500X Counselor Professional (Licence: FL MH16892) | |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2023-07-31 |