| NPI | 1023331071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH00011124) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: ID LPC - 2761) |
| Enumeration Date | 2010-03-04 |
| Last Update Date | 2010-03-04 |