| NPI | 1831717800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C7494) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0018657) |
| 101YM0800X Counselor, Mental Health (Licence: WA LH61252591) | |
| Enumeration Date | 2020-07-07 |
| Last Update Date | 2025-02-20 |