| NPI | 1770464125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R12260) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPCC.0023822) |
| Enumeration Date | 2025-09-11 |
| Last Update Date | 2025-11-05 |