| NPI | 1003151341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 87461191) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR 8741191) |
| Enumeration Date | 2012-11-27 |
| Last Update Date | 2021-09-02 |