| NPI | 1811011752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 1232) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL MH6848) |
| Enumeration Date | 2007-03-17 |
| Last Update Date | 2022-08-10 |