| NPI | 1376812305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH10915) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL MH10915) |
| Enumeration Date | 2011-12-20 |
| Last Update Date | 2022-09-21 |