| NPI | 1477833960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL SW8004) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MT3106) |
| Enumeration Date | 2011-08-28 |
| Last Update Date | 2024-04-26 |