| NPI | 1366056327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH18306) |
| Additional Taxonomies | 101YS0200X Counselor, School (Licence: FL MH18306) |
| Enumeration Date | 2020-09-06 |
| Last Update Date | 2025-03-13 |