| NPI | 1043581697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60173849) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C2920) |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2022-01-14 |