| NPI | 1285982629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH13141) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH10149) |
| Enumeration Date | 2012-08-15 |
| Last Update Date | 2017-09-14 |