| NPI | 1851996722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH16622) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9515994) |
| Enumeration Date | 2020-12-01 |
| Last Update Date | 2020-12-04 |