| NPI | 1750835047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH15358) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH13995) |
| Enumeration Date | 2016-08-04 |
| Last Update Date | 2017-10-02 |