| NPI | 1912748237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R10628) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: VA 0704016923) |
| Enumeration Date | 2024-06-03 |
| Last Update Date | 2025-01-17 |