| NPI | 1245606409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 8287475-6004) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: VA 0701013816) |
| 101YM0800X Counselor, Mental Health (Licence: WA MHC.LH.70065009) | |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2026-04-09 |