| NPI | 1285297176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL W426-501-94-303-0) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| 103TC1900X Psychologist, Counseling (Licence: FL w426-501-303-0) | |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2019-04-17 |