| NPI | 1558763599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH15859) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH14360) |
| Enumeration Date | 2014-09-22 |
| Last Update Date | 2024-01-09 |