| NPI | 1730702390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: FL 17399) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH17399) |
| 101YM0800X Counselor, Mental Health (Licence: FL 17399) | |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2020-05-18 |