| NPI | 1366898728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH13490) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IL 180.017373) |
| 101YM0800X Counselor, Mental Health (Licence: TX 98598) | |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2025-11-25 |