| NPI | 1023176146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH11689) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701001944) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2015-06-09 |