| NPI | 1376981423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C4888) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH61221488) |
| 101YP2500X Counselor, Professional (Licence: NC A10098) | |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2024-04-04 |