| NPI | 1083071260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH12759) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| Enumeration Date | 2016-01-19 |
| Last Update Date | 2019-05-31 |