| NPI | 1073876983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH19850) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OH C.0005552) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2022-10-06 |