| NPI | 1073128906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WA LH00006801) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM CCMH0170501) |
| Enumeration Date | 2020-09-08 |
| Last Update Date | 2020-09-08 |