| NPI | 1558746842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH15664) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH13555) |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2018-05-15 |