| NPI | 1326636812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C9803) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 20428) |
| Enumeration Date | 2021-01-09 |
| Last Update Date | 2026-07-10 |