| NPI | 1679786388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH15872) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: MD LC2042) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2024-08-13 |