| NPI | 1982044590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: FL MH16047) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: IL 180.010954) |
| 101YP2500X Counselor Professional (Licence: IL 180.010954) | |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2018-05-31 |