| NPI | 1255509253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL TPMC1933) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 2417) |
| 101YM0800X Counselor, Mental Health (Licence: NE 5504) | |
| 101YM0800X Counselor, Mental Health (Licence: ID 5886) | |
| 101YP2500X Counselor, Professional (Licence: CO 0014908) | |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2023-04-17 |