| NPI | 1225813439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH22754) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: MA 6401008731) |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2024-04-12 |