| NPI | 1487175709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH14792) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL 14792) |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2024-09-11 |