| NPI | 1700107836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH19729) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 7027) |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2022-10-25 |