| NPI | 1174785067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH12133) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: FL PN1258341) |
| 101YS0200X Counselor, School (Licence: FL 1033055) | |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2013-11-16 |