| NPI | 1881844272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 3268) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: UT 6093125-6004) |
| Enumeration Date | 2008-09-23 |
| Last Update Date | 2008-09-23 |