| NPI | 1265890024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C5185) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C5185) |
| 101Y00000X Counselor (Licence: OR C5185) | |
| Enumeration Date | 2016-02-08 |
| Last Update Date | 2019-04-04 |