| NPI | 1093169229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61476666) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NV CI0373) |
| 101YP2500X Counselor, Professional (Licence: AZ LAC-16020) | |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2023-11-17 |