| NPI | 1063420123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA 8481) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: OR C1666) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2008-02-14 |