| NPI | 1093465387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH23975) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH22119) |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2024-07-02 |