| NPI | 1427637388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor (Licence: OR 00117784) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2021-08-19 |