| NPI | 1912427204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH16771) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL 13690) |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2022-07-21 |