| NPI | 1417534033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH20112) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH17074) |
| Enumeration Date | 2021-03-28 |
| Last Update Date | 2022-08-16 |