| NPI | 1073872800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C7186) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C5988) |
| 101YM0800X Counselor, Mental Health (Licence: NY 001114) | |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2023-09-04 |