| NPI | 1740414200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH11748) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 101YP2500X Counselor Professional (Licence: FL MH11748) | |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2023-07-06 |