| NPI | 1720673841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 20341) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL 41912) |
| 101YM0800X Counselor, Mental Health (Licence: FL 9875703) | |
| Enumeration Date | 2021-03-02 |
| Last Update Date | 2021-03-02 |