| NPI | 1124039979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH23473) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AL 2682) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2025-06-18 |