| NPI | 1992375927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL 19939) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH21096) |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2022-08-06 |