| NPI | 1073701603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: FL MH10021) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH5176) |
| 101YM0800X Counselor, Mental Health (Licence: FL MH10021) | |
| 101YP2500X Counselor, Professional (Licence: FL IMH5176) | |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2017-07-31 |