| NPI | 1154466225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60229163) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: ME CC1087) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2012-01-26 |