| NPI | 1376055772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA LH00006162) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MI 6401013624) |
| 101YM0800X Counselor, Mental Health (Licence: WI 4520-125) | |
| 101YP2500X Counselor, Professional | |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2017-10-25 |
| Last Update Date | 2023-07-27 |