| NPI | 1467056663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH22151) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH20775) |
| Enumeration Date | 2020-11-28 |
| Last Update Date | 2023-04-25 |