| NPI | 1992939532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 173147) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL IMH4756) |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2018-08-31 |