| NPI | 1356680011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL IMH10010) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH12511) |
| Enumeration Date | 2013-01-31 |
| Last Update Date | 2021-03-30 |