| 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 |