| NPI | 1922560168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH19498) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH8509) |
| Enumeration Date | 2019-04-05 |
| Last Update Date | 2022-02-26 |