| NPI | 1194270157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC60771760) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LAC-16004) |
| Enumeration Date | 2016-08-19 |
| Last Update Date | 2023-03-08 |