| NPI | 1114691730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61263883) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: DC LGPC00649) |
| 101YM0800X Counselor, Mental Health (Licence: DC PRC200001257) | |
| Enumeration Date | 2021-08-06 |
| Last Update Date | 2023-04-03 |