| NPI | 1568084101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH17788) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor (Licence: FL 0028067) |
| Enumeration Date | 2020-05-16 |
| Last Update Date | 2020-06-20 |