| NPI | 1487278982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH23167) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: NM CCMH0171851) |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2025-02-11 |