| NPI | 1831423078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH16073) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: GA LPC005678) |
| Enumeration Date | 2009-09-21 |
| Last Update Date | 2018-11-01 |