| NPI | 1265781579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH60815437) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC 60691506) |
| 101YP2500X Counselor, Professional (Licence: OH C.1200592) | |
| Enumeration Date | 2012-08-31 |
| Last Update Date | 2019-09-21 |