| NPI | 1336505353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C4228) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C4228) |
| Enumeration Date | 2016-01-06 |
| Last Update Date | 2018-05-01 |