| NPI | 1649638164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C9283) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA 161647385) |
| Enumeration Date | 2016-01-29 |
| Last Update Date | 2025-10-13 |