| NPI | 1336646413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL mh18129) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH16318) |
| Enumeration Date | 2018-04-06 |
| Last Update Date | 2025-05-01 |