| NPI | 1770953507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH16459) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701006313) |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2019-02-01 |