| NPI | 1447618590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH14572) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL IMH12788) |
| Enumeration Date | 2016-02-03 |
| Last Update Date | 2021-09-16 |