| NPI | 1740819002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: OR 20030441LPN) |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2020-04-09 |