| NPI | 1780295170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 22327) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 84360) |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2024-04-25 |