| NPI | 1518482231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C9929) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR R7205) |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2025-05-23 |