| NPI | 1861038101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL mh18035) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH14605) |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2020-05-07 |