| NPI | 1861175275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: FL MH22274) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH22274) |
| Enumeration Date | 2023-08-11 |
| Last Update Date | 2024-01-14 |