| NPI | 1245831288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH18936) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH17904) |
| Enumeration Date | 2020-11-05 |
| Last Update Date | 2022-04-14 |