NPI | 1144654849 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101Y00000X Counselor (Licence: ID LCPC 4843) |
Additional Taxonomies | 101Y00000X Counselor (Licence: WA LH 00011315) |
101Y00000X Counselor (Licence: OR C2770) | |
Enumeration Date | 2013-08-29 |
Last Update Date | 2023-12-04 |