| NPI | 1851768626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH21483) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL IMH 10841) |
| Enumeration Date | 2015-08-28 |
| Last Update Date | 2025-06-10 |