| NPI | 1467011486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 12310252-6004) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NV CP5586-R) |
| 101YM0800X Counselor, Mental Health (Licence: OR C7878) | |
| 101YM0800X Counselor, Mental Health (Licence: ID LCPC-10067) | |
| 101YM0800X Counselor, Mental Health (Licence: WA LH61492131) | |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2024-02-05 |