| NPI | 1659623213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 10520) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL 10520) |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2022-06-14 |