| NPI | 1447749973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH15381) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC009295) |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2018-05-10 |