| NPI | 1639560576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OR L6028) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L6028) |
| 101YM0800X Counselor, Mental Health (Licence: OR L6028) | |
| Enumeration Date | 2015-02-13 |
| Last Update Date | 2015-02-18 |