| NPI | 1033458476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: MT 4429) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA LH 60174437) |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2013-02-05 |