| NPI | 1780389833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C10264) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA LH61643244) |
| 101Y00000X Counselor (Licence: OR C10264) | |
| 101YM0800X Counselor, Mental Health (Licence: TX 92900) | |
| 101Y00000X Counselor (Licence: TX 92900) | |
| 101YM0800X Counselor, Mental Health (Licence: WA LH61643244) | |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2026-03-27 |