| NPI | 1942742515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH18829) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH14665) |
| Enumeration Date | 2016-11-14 |
| Last Update Date | 2021-02-08 |