| NPI | 1851757850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH16872) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WI 6486-125) |
| 101YM0800X Counselor Mental Health (Licence: IL 180.011440) | |
| Enumeration Date | 2016-01-06 |
| Last Update Date | 2021-10-04 |