| NPI | 1518649714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 24299) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL 24299) |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2023-08-30 |