| NPI | 1902068869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH6404) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC 6983) |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2011-03-02 |