| NPI | 1245770577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH16476) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH14993) |
| Enumeration Date | 2017-03-06 |
| Last Update Date | 2019-10-21 |