| NPI | 1902459480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH18603) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL 17529) |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2023-10-30 |