| NPI | 1669623799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL FL-MH21136) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: GA GA-LPC009051) |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2024-04-02 |