| NPI | 1437699519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH16463) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL IMH15319) |
| Enumeration Date | 2017-03-08 |
| Last Update Date | 2018-11-14 |