| NPI | 1336836352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH61288061) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO LPC.0013613) |
| Enumeration Date | 2023-04-19 |
| Last Update Date | 2023-04-26 |