| NPI | 1679904791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH14147) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL ADC-010740-2015) |
| Enumeration Date | 2013-12-01 |
| Last Update Date | 2017-03-20 |