| NPI | 1811435043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201392609) |
| Enumeration Date | 2017-02-08 |
| Last Update Date | 2020-06-16 |