NPI | 1710873641 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 25-QMHP-R-3707) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical |
Enumeration Date | 2025-06-16 |
Last Update Date | 2025-07-26 |