| NPI | 1417276353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL PMHC1971) |
| 101YP2500X Counselor, Professional (Licence: GA LPC005947) | |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2022-11-30 |