| NPI | 1891831772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C7615) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR G 09-12-06) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2024-02-14 |