| NPI | 1235607334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA MC60326442) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC60326442) |
| Enumeration Date | 2018-11-06 |
| Last Update Date | 2018-12-19 |