| NPI | 1043594864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-15969) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH-60312837) |
| Enumeration Date | 2011-09-29 |
| Last Update Date | 2020-08-28 |