| NPI | 1629348933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 426481-6004) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR C3775) |
| 101YM0800X Counselor, Mental Health (Licence: WA LH60522557) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: UT 4264816009) | |
| Enumeration Date | 2012-01-03 |
| Last Update Date | 2023-04-21 |