| NPI | 1558829457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61055500) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: IN 39003508A) |
| 101YM0800X Counselor, Mental Health (Licence: OR C5666) | |
| Enumeration Date | 2019-03-10 |
| Last Update Date | 2025-09-23 |