| NPI | 1366107484 |
|---|---|
| Former Name | BROCK KLEMENT HAM |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 10038-125) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-18611) |
| 101YP2500X Counselor, Professional (Licence: MN 2751) | |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2022-11-02 |