| NPI | 1174504559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WA LH60752739) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60752739) |
| 101YM0800X Counselor, Mental Health (Licence: NM 0086491) | |
| 101YP2500X Counselor, Professional (Licence: NM 0086491) | |
| 101YP2500X Counselor, Professional (Licence: FL MH4378) | |
| 101YP2500X Counselor, Professional (Licence: CO LPC.0013914) | |
| Enumeration Date | 2005-11-11 |
| Last Update Date | 2023-01-18 |