| NPI | 1235772930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA 61172924) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CO 15216) |
| Enumeration Date | 2019-10-25 |
| Last Update Date | 2023-12-05 |