| NPI | 1346531407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C4852) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR C3392) |
| 101YM0800X Counselor, Mental Health (Licence: WI 5862-125) | |
| 101YP2500X Counselor, Professional (Licence: MI 6401012431) | |
| Enumeration Date | 2011-04-25 |
| Last Update Date | 2019-03-05 |