| NPI | 1598236465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701012966) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C6501) |
| 101YP2500X Counselor, Professional (Licence: TX 65705) | |
| 101YM0800X Counselor, Mental Health (Licence: WA MHCLH60509753) | |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2026-05-14 |