| NPI | 1679273817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR A18689) |
| Enumeration Date | 2023-03-07 |
| Last Update Date | 2026-09-02 |