| NPI | 1013289560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC60302903) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: LA CI 4799) |
| Enumeration Date | 2012-01-30 |
| Last Update Date | 2012-09-20 |