| NPI | 1053363572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH-5364) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH5364) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2020-08-09 |