| NPI | 1467797894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 7243) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: FL 283717) |
| Enumeration Date | 2012-12-12 |
| Last Update Date | 2018-05-10 |