| NPI | 1164661237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH9342) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: FL MH 9342) |
| Enumeration Date | 2009-02-13 |
| Last Update Date | 2021-04-15 |