| NPI | 1023377108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60824625) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 006460) |
| Enumeration Date | 2012-05-10 |
| Last Update Date | 2024-04-09 |