| NPI | 1508406968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH22383) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL IMH18905) |
| Enumeration Date | 2020-01-13 |
| Last Update Date | 2024-03-18 |