| NPI | 1457869034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL 17648) |
| Enumeration Date | 2018-01-17 |
| Last Update Date | 2024-03-25 |