| NPI | 1164156808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH22640) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| Enumeration Date | 2022-07-09 |
| Last Update Date | 2023-08-22 |