| NPI | 1578198248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL IMH18786) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: TX 84042) |
| Enumeration Date | 2020-03-03 |
| Last Update Date | 2023-06-01 |