| NPI | 1003918772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: FL MH5912) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH5912) |
| 101YP2500X Counselor, Professional (Licence: FL MH5912) | |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2022-07-21 |