| NPI | 1679829329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL IMH20178) |
| Additional Taxonomies | 251B00000X Case Management |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2022-11-02 |