| NPI | 1265962484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL LMHC2710) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL 2710) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2017-06-20 |