| NPI | 1548658263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C3843) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NE 4452) |
| 101YM0800X Counselor, Mental Health (Licence: OR C3843) | |
| 101YP2500X Counselor, Professional (Licence: NE 2167) | |
| Enumeration Date | 2015-01-05 |
| Last Update Date | 2021-05-04 |