| NPI | 1568725604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 101Y00000X Counselor |
| 171M00000X Case Manager/Care Coordinator (Licence: OR 10-12-19) | |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2019-12-05 |