| NPI | 1003331943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR c6595) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR R4295) |
| Enumeration Date | 2017-08-11 |
| Last Update Date | 2022-02-10 |