| NPI | 1124367339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR A11643) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YM0800X Counselor, Mental Health (Licence: WA SC61635105) | |
| 372600000X Adult Companion | |
| Enumeration Date | 2013-02-07 |
| Last Update Date | 2026-02-17 |