| NPI | 1225237787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: FL MH10014) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH00007699) |
| Enumeration Date | 2007-07-15 |
| Last Update Date | 2015-02-16 |