| NPI | 1114201407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH11616) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH 8191) |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2026-05-31 |