| NPI | 1831067370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 10004385) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 10004385) |
| Enumeration Date | 2025-10-27 |
| Last Update Date | 2025-10-27 |