| NPI | 1215639646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH22527) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH19231) |
| Enumeration Date | 2023-03-20 |
| Last Update Date | 2023-08-08 |