| NPI | 1356631410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 10553) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39002156A) |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2011-04-11 |