| NPI | 1164944575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD LC8947) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL TPMC1042) |
| 101YP2500X Counselor, Professional (Licence: MD LC8947) | |
| 101YP2500X Counselor, Professional (Licence: FL TPMC1042) | |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2023-03-13 |