| NPI | 1407303902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OR L13120) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: OR L13102) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2023-10-18 |