| NPI | 1871100339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR L11190) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR L10313) |
| Enumeration Date | 2020-09-29 |
| Last Update Date | 2026-06-30 |