| NPI | 1558608711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 805-020-771) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: FL 51190) |
| Enumeration Date | 2013-01-08 |
| Last Update Date | 2013-02-26 |