| NPI | 1255443636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60983909) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180002800) |
| 101Y00000X Counselor (Licence: WA LH60983909) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2023-03-07 |