| NPI | 1659025864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL IMH13250) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL IMH13250) |
| 101YP1600X Counselor, Pastoral (Licence: FL IMH13250) | |
| 172V00000X Community Health Worker (Licence: FL IMH13250) | |
| 222Q00000X Developmental Therapist | |
| Enumeration Date | 2022-02-07 |
| Last Update Date | 2022-02-28 |