| NPI | 1285940270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WA LH60174978) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA LH60174978) |
| 101YP2500X Counselor Professional (Licence: TX 16004) | |
| Enumeration Date | 2010-08-27 |
| Last Update Date | 2010-08-27 |