| NPI | 1508135583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR L15503) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: GA csw004661) |
| Enumeration Date | 2011-12-21 |
| Last Update Date | 2025-09-24 |