| NPI | 1427605781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH20748) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL IMH16231) |
| Enumeration Date | 2019-08-21 |
| Last Update Date | 2022-06-10 |