NPI | 1033630512 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61056175) |
Additional Taxonomies | 101Y00000X Counselor (Licence: WA MC60894403) |
101YM0800X Counselor, Mental Health | |
Enumeration Date | 2017-07-05 |
Last Update Date | 2022-07-21 |