| NPI | 1912155912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH17611) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AL C1505A) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2020-01-29 |