| NPI | 1467617829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH5271) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL 5271) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2024-05-08 |