| NPI | 1407207962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C8091) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101Y00000X Counselor | |
| 101YM0800X Counselor, Mental Health | |
| 101YM0800X Counselor, Mental Health (Licence: OR 19-QMHPC-00934) | |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2024-05-06 |