| NPI | 1710531314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH17239) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY2385) |
| Enumeration Date | 2019-07-31 |
| Last Update Date | 2019-07-31 |