| NPI | 1437349040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH9410) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: UT 12694114-6004) |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2025-01-28 |