| NPI | 1760491963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: FL MH2106) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH2106) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2023-04-13 |