| NPI | 1336370238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH00011117) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401013679) |
| Enumeration Date | 2009-07-27 |
| Last Update Date | 2015-11-04 |