NPI | 1295716082 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH# 0004350) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: FL MH# 0004350) |
Enumeration Date | 2005-11-08 |
Last Update Date | 2007-07-08 |