| NPI | 1568978468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH15527) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY MH008574) |
| 101YP2500X Counselor, Professional (Licence: GA LPC011601) | |
| Enumeration Date | 2017-12-15 |
| Last Update Date | 2023-05-24 |