| NPI | 1497471734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH22102) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL IMH20906) |
| Enumeration Date | 2022-10-18 |
| Last Update Date | 2026-07-07 |