| NPI | 1245939768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C9131) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: FL MH24467) |
| 101YP2500X Counselor, Professional (Licence: FL MH24467) | |
| 101YP2500X Counselor, Professional (Licence: OR C9131) | |
| Enumeration Date | 2023-02-23 |
| Last Update Date | 2024-11-20 |