| NPI | 1043525033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO LPC0018179) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA 60625261) |
| 101YP2500X Counselor, Professional (Licence: TX 64590) | |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2022-05-06 |