| NPI | 1417544966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH26345) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH20303) |
| Enumeration Date | 2020-12-30 |
| Last Update Date | 2025-08-25 |