| NPI | 1730844291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH20207) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| Enumeration Date | 2021-11-01 |
| Last Update Date | 2024-10-03 |