| NPI | 1306311931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH19081) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH E2001805) |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2023-10-26 |