| NPI | 1821335001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 11423) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL 11393) |
| Enumeration Date | 2013-01-08 |
| Last Update Date | 2023-11-08 |