| NPI | 1588036693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH1729) |
| Additional Taxonomies | 104100000X Social Worker (Licence: FL MH1729) |
| Enumeration Date | 2015-10-28 |
| Last Update Date | 2019-07-23 |