| NPI | 1336807478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH25060) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 13401) |
| Enumeration Date | 2021-12-06 |
| Last Update Date | 2025-02-04 |