| NPI | 1366647018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH0001683) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL MH 0001683) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2014-01-09 |