| NPI | 1992935316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH23687) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401011293) |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2024-11-04 |