| NPI | 1396470027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 202009262RN) |
| Enumeration Date | 2022-07-18 |
| Last Update Date | 2022-07-18 |