| NPI | 1972209039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 5008) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: FL 1653572) |
| Enumeration Date | 2023-01-31 |
| Last Update Date | 2023-01-31 |