| NPI | 1124638408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH20832) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH17157) |
| Enumeration Date | 2020-08-03 |
| Last Update Date | 2022-05-24 |