| NPI | 1255460424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: KY 284449) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH00005905) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2024-11-03 |