| NPI | 1437518073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 25269) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2016-02-10 |
| Last Update Date | 2024-01-14 |