| NPI | 1922331891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 98553) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YM0800X Counselor, Mental Health (Licence: OR T1295) | |
| 101YM0800X Counselor, Mental Health (Licence: OR C4007) | |
| Enumeration Date | 2009-09-10 |
| Last Update Date | 2025-08-11 |