| NPI | 1164548707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH61548117) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: TX 19974) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2024-08-28 |