| NPI | 1124560438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 247200000X Technician, Other |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH 14240) |
| Enumeration Date | 2016-11-17 |
| Last Update Date | 2016-11-17 |