| NPI | 1740547322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 11680) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH10198) |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2023-12-15 |