| NPI | 1124349592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: HI MHC349) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60275244) |
| Enumeration Date | 2010-06-18 |
| Last Update Date | 2015-08-25 |