| NPI | 1700431434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH20854) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO NLC.0109178) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2022-08-15 |