| NPI | 1841711538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MT3395) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMT2296) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2022-07-21 |