| NPI | 1235356791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60102057) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: UT 5336002-6004) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2023-11-15 |