| NPI | 1184889248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: WA LH00009017) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: ID LCPC-3135) |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2024-07-09 |