| NPI | 1306233556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR T1947) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 953144808) |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2022-01-05 |