| NPI | 1083059331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WA LH60683747) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NY 004136) |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2022-07-21 |