| NPI | 1689926768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH4484) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NC 10642) |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2015-06-01 |