| NPI | 1710492665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH19962) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH14352) |
| 146L00000X Emergency Medical Technician, Paramedic (Licence: FL PMD517006) | |
| Enumeration Date | 2017-12-13 |
| Last Update Date | 2021-11-18 |