| NPI | 1891208393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL SW14904) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: FL SW14904) |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2023-07-21 |