| NPI | 1972958262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH15212) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL i13679) |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2017-07-25 |