| NPI | 1922718659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH24052) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH20845) |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2024-08-04 |