| NPI | 1003588005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C10570) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0019970) |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2026-09-01 |