| NPI | 1447918503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH23444) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH21904) |
| Enumeration Date | 2021-12-06 |
| Last Update Date | 2024-11-04 |