| NPI | 1740990167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH25535) |
| Additional Taxonomies | 364SP0813X Clinical Nurse Specialist, Psych/Mental Health, Geropsychiatric (Licence: FL IMH20904) |
| Enumeration Date | 2022-11-28 |
| Last Update Date | 2025-04-11 |