| NPI | 1003963968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 21127) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH4235) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2025-02-27 |