| NPI | 1093116709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C4920) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0013855) |
| 101YM0800X Counselor, Mental Health (Licence: OR C4920) | |
| Enumeration Date | 2014-09-12 |
| Last Update Date | 2018-07-27 |