| NPI | 1063978781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA LH61397858) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-17751) |
| Enumeration Date | 2019-02-18 |
| Last Update Date | 2023-08-07 |