| NPI | 1063139350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH25163) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH22774) |
| Enumeration Date | 2022-10-26 |
| Last Update Date | 2026-01-07 |