| NPI | 1477093235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH19941) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: AL 8627) |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2021-12-21 |