| NPI | 1962804898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH16268) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 15725) |
| 101YM0800X Counselor, Mental Health (Licence: OH E.2303934) | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2024-02-06 |