| NPI | 1700309945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 13522) |
| Additional Taxonomies | 101YS0200X Counselor, School |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2022-07-21 |