| NPI | 1023324613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 10187) |
| 101YM0800X Counselor, Mental Health (Licence: FL 15484) | |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2023-12-21 |