| NPI | 1851998546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH21802) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VT 068.0134260) |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2023-08-29 |