| NPI | 1770593543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH8343) |
| Additional Taxonomies | 251K00000X Public Health or Welfare (Licence: FL MH8343) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2007-07-08 |