| NPI | 1083053300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC 60330693) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: KS 2414) |
| Enumeration Date | 2013-06-19 |
| Last Update Date | 2013-06-19 |