| NPI | 1770880304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 13861) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 8528) |
| Enumeration Date | 2011-02-16 |
| Last Update Date | 2016-02-02 |