| NPI | 1821411158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL IMH10481) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH12952) |
| Enumeration Date | 2014-01-22 |
| Last Update Date | 2019-07-17 |