| NPI | 1114565363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: FL MH4687) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL 4687) |
| Enumeration Date | 2019-12-18 |
| Last Update Date | 2025-10-02 |