| NPI | 1265789689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH12851) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH 9846) |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2022-11-30 |