| NPI | 1326303207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH12517) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH6060) |
| Enumeration Date | 2012-07-07 |
| Last Update Date | 2019-08-22 |