| NPI | 1780652685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH22029) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: SC 2167) |
| 101YM0800X Counselor Mental Health (Licence: LA 3658) | |
| 101YM0800X Counselor Mental Health (Licence: AL 1829) | |
| 101YP2500X Counselor Professional | |
| 101YP2500X Counselor Professional (Licence: SC 2167) | |
| 101YP2500X Counselor Professional (Licence: AL 1829) | |
| 101YP2500X Counselor Professional (Licence: LA 3658) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2024-02-06 |