| NPI | 1912457482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH1271) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: FL SS185) |
| Enumeration Date | 2016-10-09 |
| Last Update Date | 2016-10-09 |