| NPI | 1376165969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CO LPC.0015656) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA 60867259) |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2020-05-18 |