| NPI | 1407347347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 20182375RN) |
| Enumeration Date | 2018-05-26 |
| Last Update Date | 2018-06-26 |