| NPI | 1295586394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC61547805) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: TX 94595) |
| Enumeration Date | 2024-03-28 |
| Last Update Date | 2024-04-22 |