| NPI | 1023460102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OR C3918) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA LH60571272) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2019-06-19 |