| NPI | 1386879732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH9898) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL MH9898) |
| 101YP2500X Counselor, Professional (Licence: FL MH9898) | |
| Enumeration Date | 2009-05-28 |
| Last Update Date | 2009-10-30 |