| NPI | 1518726421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL IMH23774) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL IMH23774) |
| Enumeration Date | 2024-03-14 |
| Last Update Date | 2024-03-14 |