| NPI | 1093186488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61468938) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ lac-22090) |
| Enumeration Date | 2015-10-12 |
| Last Update Date | 2023-07-28 |