| NPI | 1063023315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C7400) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR R6409) |
| Enumeration Date | 2020-08-11 |
| Last Update Date | 2023-11-28 |