| NPI | 1528764065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C9513) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR R8169) |
| Enumeration Date | 2023-02-06 |
| Last Update Date | 2025-02-11 |