| NPI | 1992398846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH19499) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL MH19499) |
| 101YM0800X Counselor, Mental Health (Licence: FL MH17564) | |
| Enumeration Date | 2021-02-11 |
| Last Update Date | 2022-06-15 |