| NPI | 1992370977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH19175) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL 115564) |
| Enumeration Date | 2021-05-23 |
| Last Update Date | 2021-09-17 |