| NPI | 1831795277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 18389) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: FL 18389) |
| 101YP2500X Counselor, Professional (Licence: FL 18389) | |
| Enumeration Date | 2020-12-10 |
| Last Update Date | 2020-12-10 |