| NPI | 1538710975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OR C8228) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: FL MH12908) |
| Enumeration Date | 2019-09-26 |
| Last Update Date | 2024-08-21 |