| NPI | 1275165094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL SW22042) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL ISW13410) |
| Enumeration Date | 2020-02-10 |
| Last Update Date | 2023-10-16 |