| NPI | 1578878690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH 10029) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701004541) |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2017-03-31 |